Thomas M Vollbrecht, Luis F Goncalves, Dianna M E Bardo, Christopher Hart, Heide Boeth, Alex J Barker, Richard M Friesen, Julian A Luetkens
{"title":"Factors Influencing Image Quality in Fetal Cardiac Cine MRI Using Doppler US Gating:A Multicenter Study.","authors":"Thomas M Vollbrecht, Luis F Goncalves, Dianna M E Bardo, Christopher Hart, Heide Boeth, Alex J Barker, Richard M Friesen, Julian A Luetkens","doi":"10.1016/j.jocmr.2025.101875","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Fetal cardiac cine MRI is an emerging technique for evaluating the fetal heart in conditions such as congenital heart disease, but limited evidence on factors affecting image quality restricts its clinical potential. This study investigated key determinants of image quality in a multicenter cohort.</p><p><strong>Methods: </strong>This study analyzed fetal cardiac MRI scans from April 2021 to July 2023 at three centers (University Hospital Bonn, Children's Hospital Colorado, Phoenix Children's Hospital). Cine image quality was assessed using a 5-point Likert scale (1=non-diagnostic to 5=excellent) across three criteria: contour sharpness, blood-to-structure contrast, and artifacts. Overall image quality scores were calculated by the average of all criteria. Apparent signal-to-noise (aSNR) and contrast-to-noise ratios (aCNR) were measured. Nine parameters were evaluated for their impact on image quality: gestational age, body mass index (BMI), fetal motion, patient positioning, gating signal stability, breathing technique, field strength, slice thickness, and flip angle. Comparisons were conducted using the Mann-Whitney U test.</p><p><strong>Results: </strong>A total of 98 scans were analyzed. Higher overall image quality, aSNR, and aCNR were observed in participants with BMI <30kg/m², gestational age ≥32 weeks, low fetal motion severity, and stable gating signals (e.g., overall image quality for BMI <30kg/m² vs ≥30kg/m²: 4.4 ± 0.7 vs. 4.1 ± 0.7, p <0.001). Supine positioning resulted in better overall image quality compared to the left lateral position (4.5 ± 0.5 vs. 4.2 ± 0.8, p = 0.001). Breath-holds provided similar overall image quality but improved contour sharpness and reduced artifacts compared to free breathing (5 [4-5] vs. 4 [4-5], p = 0.042; and 4 [3-5] vs. 4 [3-5], p = 0.014, respectively). At 1.5T field strength, higher contrast and fewer artifacts were observed compared to 3T (5 [4-5] vs. 5 [4-5], p = 0.041; and 4 [4-5] vs. 4 [3-5], p = 0.010, respectively). Slice thickness showed no significant impact on image quality.</p><p><strong>Conclusions: </strong>Various factors (e.g. BMI) influence fetal cardiac cine MRI image quality. Understanding these factors may help achieving reliable examinations and better exploit the potential of fetal cardiac MRI in clinical routine.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101875"},"PeriodicalIF":4.2000,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Magnetic Resonance","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jocmr.2025.101875","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Fetal cardiac cine MRI is an emerging technique for evaluating the fetal heart in conditions such as congenital heart disease, but limited evidence on factors affecting image quality restricts its clinical potential. This study investigated key determinants of image quality in a multicenter cohort.
Methods: This study analyzed fetal cardiac MRI scans from April 2021 to July 2023 at three centers (University Hospital Bonn, Children's Hospital Colorado, Phoenix Children's Hospital). Cine image quality was assessed using a 5-point Likert scale (1=non-diagnostic to 5=excellent) across three criteria: contour sharpness, blood-to-structure contrast, and artifacts. Overall image quality scores were calculated by the average of all criteria. Apparent signal-to-noise (aSNR) and contrast-to-noise ratios (aCNR) were measured. Nine parameters were evaluated for their impact on image quality: gestational age, body mass index (BMI), fetal motion, patient positioning, gating signal stability, breathing technique, field strength, slice thickness, and flip angle. Comparisons were conducted using the Mann-Whitney U test.
Results: A total of 98 scans were analyzed. Higher overall image quality, aSNR, and aCNR were observed in participants with BMI <30kg/m², gestational age ≥32 weeks, low fetal motion severity, and stable gating signals (e.g., overall image quality for BMI <30kg/m² vs ≥30kg/m²: 4.4 ± 0.7 vs. 4.1 ± 0.7, p <0.001). Supine positioning resulted in better overall image quality compared to the left lateral position (4.5 ± 0.5 vs. 4.2 ± 0.8, p = 0.001). Breath-holds provided similar overall image quality but improved contour sharpness and reduced artifacts compared to free breathing (5 [4-5] vs. 4 [4-5], p = 0.042; and 4 [3-5] vs. 4 [3-5], p = 0.014, respectively). At 1.5T field strength, higher contrast and fewer artifacts were observed compared to 3T (5 [4-5] vs. 5 [4-5], p = 0.041; and 4 [4-5] vs. 4 [3-5], p = 0.010, respectively). Slice thickness showed no significant impact on image quality.
Conclusions: Various factors (e.g. BMI) influence fetal cardiac cine MRI image quality. Understanding these factors may help achieving reliable examinations and better exploit the potential of fetal cardiac MRI in clinical routine.
期刊介绍:
Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to:
New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system.
New methods to enhance or accelerate image acquisition and data analysis.
Results of multicenter, or larger single-center studies that provide insight into the utility of CMR.
Basic biological perceptions derived by CMR methods.